Veterans quietly manage ear pain

On his two deployments to Iraq with the 18th Airborne Corps, Spc. Jon Michael Cripps spent more time keeping the Army's computers running than he did in combat, but he can't forget what he heard.

The constant roar of generators, along with the hum of computer servers and the high-powered air conditioners required to cool them, damaged Cripps' hearing and left an intermittent ringing in his ears.

"You think about maybe getting wounded in battle, getting those kinds of scars," Cripps said after his annual hearing test at a health center on post recently. "Losing your hearing is just not something you think about."

But it's a widespread problem that affects the quality of service members' lives now and will worsen in decades to come. And it's largely preventable.

At least a quarter of soldiers who have served in Iraq or Afghanistan show some hearing loss, Army audiologists say, and even those who don't deploy often are exposed to constant or concussive noises in their work or training that can cause hearing loss or tinnitus, a ringing in the ears. As they grow older, their normal, age-related hearing loss will compound the problem.

Among veterans, tinnitus and hearing loss are the most common service-connected disabilities, with more than 1.5 million veterans receiving compensation for those problems at the end of 2011. Of about 805,000 veterans who began receiving disability compensation that year, nearly 148,000 were for tinnitus or hearing loss, according to a recent VA report. By comparison, the next most prevalent disability was post-traumatic stress disorder, for which about 42,700 veterans began receiving compensation in 2011.

The military tries to prevent hearing loss among active-duty soldiers, and for those who find themselves straining to hear years after they're out of service, the Veterans Administration provides hearing aids. At both ends of the spectrum, audiologists find resistance among those they're trying to help.

"For us, a lot of the work is in education," said Capt. Latisha Scott, an audiologist at Fort Bragg. "Having the equipment to prevent hearing loss is not the problem. It's getting the soldiers to buy into using it."

Scott says she — and other specialists the Army has hired in recent years to combat hearing loss — are working against outdated ideas that hearing protection is uncomfortable, unnecessary, or looks silly.

"Hearing loss used to be kind of a badge of honor," Scott said. "If you had hearing loss, you had heard the guns of war. Your loss of hearing was your proof."

For several years, each branch of the military has taught its members what causes hearing loss and tinnitus and drilled the lesson that once hearing is damaged it can almost never be repaired.

Most hearing loss and tinnitus in the military are noise-induced, specialists say. Depending on their jobs, service members may be exposed to the constant noise of machinery, engines or airplanes or to sudden loud sounds such as artillery and mortar fire or the explosion of a roadside bomb. For reasons not fully understood, not everyone exposed to the same level of noise will experience a problem.

All Army soldiers must have an annual hearing test, and those deploying are tested before they leave and after they return so there is a record of any change. To speed the process, clinics across Fort Bragg are set up with chambers where six to eight soldiers can be tested at a time. During busy deployment cycles, hundreds of soldiers may be tested each day.

If the test indicates hearing loss, the soldier is scheduled for a retest, in case the problem is a temporary issue such as fluid in the ear. If further testing shows a permanent loss, the soldier meets with Scott or another specialist to discuss the extent of the damage and ways to prevent it from getting worse.

In some cases, the loss may make it necessary for the soldier to be reassigned to another job, something Scott says most soldiers will do nearly anything to avoid, including starting to wear protection.

"You have to look at the whole picture," she said. "Are you becoming a safety hazard to yourself and others because you can't hear well enough? Can you effectively do the job?"

Just as important, she said, is understanding that with noise-induced hearing loss, returning to the same environment is likely to cause additional damage.

"You're 21 years old and in the Army now," Scott tells some of those soldiers. "But what about later, when you're married and you can't communicate with your spouse or your kids? It becomes a quality-of-life issue."

Part of Scott's job is to go from the clinic to the places on post where soldiers train or work and teach them about hearing conservation. She takes along her "tackle box," filled with hundreds of pairs of different types and sizes of earplugs for which the Army pays from a few pennies each to about $12. When they come into the Army, soldiers are issued a set of earplugs, but if they lose that set, many soldiers never bother to replace it. Scott hands out new ones like candy.

Even the best-fitting earplugs, though, block only about 23 decibels of sound. An M16 generates about 155 decibels; an IED up to 170. Hearing loss can occur at 85 decibels.

To counter one reason soldiers say they don't wear protection, the newest generation of rubber plugs Scott hands out feature a toggle in the end that can be opened manually — with the plug still in the ear — to allow for normal conversation. A sudden loud noise automatically closes the flap.

Soldiers in the Special Forces and certain other units are outfitted with high-end electronic headphones that protect against noise but can amplify desired sounds, such as a whispered voice, and can be connected to military radios and other devices. They cost the military up to $700 a set.

Cripps says most of his damage is to his left ear, and the ringing he hears is not bad enough to keep him awake at night. At 34, he can't hear certain high-pitched sounds, such as a fan or water running somewhere in his house. He says he hears everything his son and daughter say, and most of what his wife tells him, "unless it has to do with the trash or the dishes."

Cripps admits he often did not wear the ear protection he was issued while he was in Iraq, for the same reason other soldiers don't. They worry earplugs might dull their senses, saving their hearing but maybe costing their lives.

"You want to hear the whistling of the mortars," Cripps said, "before you hear the boom."